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According to an editorial published in the Journal of the American Medical Association, written by an advisory panel to the National Cancer Institute, only the lesions that typically kill if left untreated should be classified as cancer. Too many people hear only "cancer" when diagnosed with non-growing carcinomas and end up on operating tables when they don't need surgery, the authors said.
They went on to say that cancer has been overdiagnosed and often leads to overtreatment. They suggest that the term "cancer" not even be applied to non-growing or slow-growing carcinomas. Instead, they propose calling them "IDLE," which stands for "indolent lesions of epithelial origin," referring to their seemingly lazy behavior.
Dr. Otis W. Brawley, chief medical officer of the American Cancer Society agrees with the panel, which includes some of the nation's top cancer researchers. He said that a new classification for this disease is necessary to replace the outdated one based off of the observations of German pathologists in the 1850s.
"The truth be told, this is very much kind of like racial profiling," Brawley said. "It looks like what killed somebody 160 years ago, but that doesn't mean it is going to grow, spread and kill. It may very well be genomically programmed to stay just a 5-millimeter lesion for the next 70 years."
One such example is ductal carcinoma in situ. Although it is considered a type of breast cancer, Brawley says it is actually an IDLE condition. When women are diagnosed with this condition, they tend to focus on the word "carcinoma," which scares some patients into having their breasts surgically removed, even though these tumors might never grow or spread.
Dr. Jeff Patton, chief executive officer of Tennessee Oncology, said true cancer cells invade other cells, while ductal carcinoma in situ cells stay within the milk duct.
"As long as those cells don't do something that hurts you, it's not cancer," said Patton. "It's not just the cell itself. It is the biology of how it behaves."
Physicians may find it hard to implement such proposals for cancer classifications.
"It's a double-edged sword," Patton said. "We want people to be comfortable with cancer, but we don't want them to take it lightly."
Men with prostate cancer often experience widespread complications after surgery or radiation therapy, according to research by Vanderbilt University. Most men are rendered impotent by either therapy and more than one third who receive the radiation treatment develop issues controlling their bowels.
Dr. David Penson, the senior author of the Vanderbilt study, said that the tumors in at least a third of men with prostate cancer are slow growing and can be closely monitored. He agrees that new terms are necessary to better define lethal cancer.
"Whether you are using a term like IDLE, indeterminate or indolent, if you take away the word 'cancer,' people get to see things a lot differently," Penson said.
He continued, saying that patients diagnosed with cancer often demand aggressive treatment, even for non-growing or slow-growing forms. If the physician refuses to offer aggressive treatment, that doctor can then be sued for malpractice, putting them in a tough situation.
"You are painted in a corner," Penson said. "It's almost the perfect storm because you have a patient who, even though they have been told it is slow-growing and it is not a problem, they have been told they have cancer. What they want is certainty."
